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증 례 : 경피적 접근이 어려워 초음파내시경 유도 하 배액술로 치료한 췌십이지장 절제술 후 발생한 복강 소낭 내 체액 저류 1예
최청조 ( Chung Jo Choi ),문성훈 ( Sung Hoon Moon ),김종혁 ( Jong Hyeok Kim ),박지원 ( Ji Won Park ),김성은 ( Sung Eun Kim ),박충기 ( Choong Kee Park ),전장용 ( Jang Yong Jeon ) 대한췌담도학회 2015 대한췌담도학회지 Vol.20 No.4
수술 후 체액 저류는 췌십이지장절제술 후 발생할 수 있는 중요한 합병증 중 하나로 이로 인해 사망률과 재원 기간이 증가할 수도 있다. 초음파내시경 유도 하 배액은 췌장 가성낭종의 치료 방법 중 하나이며 최근에는 수술 후 발생한 체액 저류 치료에 있어서도 성공적인 사례들이 보고되고 있다. 60세 여성이 한 달 동안 4 kg의 체중감소와 5일 전부터 발생한 황달을 주소로 내원하였다. 복부 전산화단층촬영 및 내시경 역행성 담췌관 조영술을 이용한 조직검사를 통하여 총담관암이 진단되어 췌십이지장절제술을 시행하였고 수술 2주째 발열, 복통, 백혈구 증가의 임상증상을 보였다. 진단을 위해 시행한 복부 전산화단층촬영에서 소낭의 위오목에 체액저류가 증가하여 내시경적 배액술을 시행하였고 이후 합병증 없이 증상이 호전되었다. 국내에서는 아직 췌십이지장절제술 후 발생한 체액 저류를 내시경적 배액으로 치료한 증례가 보고된 바 없기에 문헌 고찰과 함께 보고하는 바이다. Postoperative fluid collection is a major complication after pancreaticoduodenectomy and can lead to increased mortality and hospital length of stay. External drainage has widely been used for postoperative fluid collections. Recently, EUS-guided drainage has also been used successfully in treating postoperative fluid collections. A 60-year-old woman was admitted due to weight loss and jaundice. She underwent pancreaticoduodenectomy for cholangiocarcinoma of the common bile duct. After 2 weeks, she had fever with abdominal pain and leukocytosis. CT showed a increased fluid collection in superior recess of lesser sac and EUS-guided drainage was performed. The symptoms resolved without any complication after drainage. This is the first case report of EUS-guided drainage for lesser sac in Korea.
췌십이지장 누공을 동반한 췌관내 유두상 점액 종양의 내시경적 진단
최청조 ( Chung Jo Choi ),문성훈 ( Sung Hoon Moon ),김자경 ( Ja Kyung Kim ),김범준 ( Bum Joon Kim ),박지원 ( Ji Won Park ),강호석 ( Ho Suk Kang ),김종혁 ( Jong Hyeok Kim ),박충기 ( Choong Kee Park ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.1
Intraductal papillary mucinous neoplasm of the pancreas (IPMN) is characterized by the production of mucin and marked dilatation of pancreatic duct. There are only several cases reports about fistula formation with adjacent organs in IPMN. A 61-year-old man was admitted due to jaundice and weight loss. CT scans showed that multiloculated cystic mass had replaced the body and tail of the pancreas. Interestingly, a fistula was found between cystic mass and duodenal bulb. With a diagnosis of malignant IPMN and pancreatoduodenal fistula, endoscopic forcepbiopsy was performed at the orifice of the fistula and pancreatic duct, through the fistula, under a fluoroscopic guidance. Pathologic examination showed only inflammatory cells. Direct peroral pancreatoscopy was performed through the pancreatoduodenal fistula using a standard upper endoscope with saline irrigation. Endoscopic forcep-biopsy was performed on the papillary tumor. Pathologic examination revealed intestinal type IPMN and radical total pancreatectomy was performed. Pathologic examination of the surgical specimen showed tubular adenocarcinoma arising from 15 cm sized intestinal type IPMN. Korean J Pancreatobiliary 2014;19(1):47-51
증례 : 소화기 ; Terlipressin 투여 후 발생한 저나트륨혈증에 의한 간질발작 1예
김진희 ( Jin Hee Kim ),김자경 ( Ja Kyung Kim ),문소영 ( So Yeong Mun ),최청조 ( Chung Jo Choi ),박한민 ( Han Min Park ),정용설 ( Yong Seol Jeong ),강준구 ( Jun Goo Kang ) 대한내과학회 2014 대한내과학회지 Vol.87 No.3
Terlipressin has splanchnic vasoconstrictive effects, and is generally used for the management of gastroesophageal variceal bleeding secondary to liver cirrhosis. Terlipressin is a synthetic arginine vasopressin (AVP) analog containing a nonapeptide sequence. Terlipressin has increased selectivity for the V1 receptor, compared with AVP; hence, it is considered to be a safe vasoconstrictor. However, side effects such as hyponatremia and seizure, although very rare, have been reported. Hyponatremia related to terlipressin may be caused by the syndrome of inappropriate antidiuresis (SIAD), which is a disorder of sodium and water balance characterized by hypotonic hyponatremia without elevation of the antidiuretic hormone level. Here, we report a case of hyponatremic seizure induced by an infusion of terlipressin in a 52-year-old female who had isolated gastric variceal bleeding secondary to alcoholic liver cirrhosis. (Korean J Med 2014;87:323-327)
빈뇨와 복통, 설사로 발현된 방광과 위장관을 동시 침범한 과호산구증가증후군 1예
김자경 ( Ja Kyung Kim ),김주희 ( Joo Hee Kim ),박한민 ( Han Min Park ),정용설 ( Yong Seol Jeong ),최청조 ( Chung Jo Choi ),나성균 ( Seong Kyun Na ),김종혁 ( Jong Hyeok Kim ),송영림 ( Young Rim Song ),황용일 ( Yong Il Hwang ),장승 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1
Idiopathic hypereosinophilic syndrome (IHES) is a rare disorder defined by persistent blood eosinophilia, evidence of eosinophil-associated organ dysfunction and absence of secondary causes. Eosinophilic infiltration and its mediator release can cause damage to multiple organs. Although IHES can involve every organ system, bladder involvement is rarely evidenced. We recently reported a case of IHES with both bladder and gastrointestinal tract involvement. A 43-year-old woman visited Hallym University Sacred Heart Hospital complaining of urinary frequency, abdominal pain, and diarrhea for several months. Abdominal pelvic computed tomographic scan showed diffuse wall thickenings in her bladder and colon with small pelvic ascites. Laboratory investigation showed a marked peripheral eosinophilia and tissue biopsies confirmed eosinophilic infiltration in the bladder wall, esophagus, and duodenum. The patient was treated with prednisolone and her eosinophilia and symptoms have gradually improved.